Imperial College London
Alternate

ProfessorKathMaitland

Faculty of Medicine, Department of Surgery & Cancer

Professor of Tropical Paediatric Infectious Disease
 
 
 
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Contact

 

k.maitland CV

 
 
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Location

 

Based full-time at KEMRI/Wellcome Programme, KenyaQueen Elizabeth and Queen Mary HospitalSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Passmore:2019:10.1016/j.thromres.2019.02.015,
author = {Passmore, MR and Obonyo, NG and Byrne, L and Boon, A-C and Diab, SD and Dunster, KR and Fung, YL and Spanevello, MM and Fauzi, MH and Pedersen, SE and Simonovah, G and Anstey, CM and Shekar, K and Tung, J-P and Maitland, K and Fraser, JF},
doi = {10.1016/j.thromres.2019.02.015},
journal = {Thrombosis Research: vascular obstruction, hemorrhage and hemostasis},
pages = {39--45},
title = {Fluid resuscitation with 0.9% saline alters haemostasis in an ovine model of endotoxemic shock},
url = {http://dx.doi.org/10.1016/j.thromres.2019.02.015},
volume = {176},
year = {2019}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - IntroductionFluid resuscitation is a cornerstone of severe sepsis management, however there are many uncertainties surrounding the type and volume of fluid that is administered. The entire spectrum of coagulopathies can be seen in sepsis, from asymptomatic aberrations to fulminant disseminated intravascular coagulation (DIC). The aim of this study was to determine if fluid resuscitation with saline contributes to the haemostatic derangements in an ovine model of endotoxemic shock.Materials and methodsTwenty-one adult female sheep were randomly divided into no endotoxemia (n=5) or endotoxemia groups (n=16) with an escalating dose of lipopolysaccharide (LPS) up to 4μg/kg/h administered to achieve a mean arterial pressure below 60mmHg. Endotoxemia sheep received either no bolus fluid resuscitation (n=8) or a 0.9% saline bolus (40mL/kg over 60min) (n=8). No endotoxemia, saline only animals (n=5) underwent fluid resuscitation with a 0.9% bolus of saline as detailed above. Hemodynamic support with vasopressors was initiated if needed, to maintain a mean arterial pressure (MAP) of 60-65mmHg in all the groups.ResultsRotational thromboelastometry (ROTEM®) and conventional coagulation biomarker tests demonstrated sepsis induced derangements to secondary haemostasis. This effect was exacerbated by saline fluid resuscitation, with low pH (p=0.036), delayed clot initiation and formation together with deficiencies in naturally occurring anti-coagulants antithrombin (p=0.027) and Protein C (p=0.001).ConclusionsEndotoxemia impairs secondary haemostasis and induces changes in the intrinsic, extrinsic and anti-coagulant pathways. These changes to haemostasis are exacerbated following resuscitation with 0.9% saline, a commonly used crystalloid in clinical settings.
AU  - Passmore,MR
AU  - Obonyo,NG
AU  - Byrne,L
AU  - Boon,A-C
AU  - Diab,SD
AU  - Dunster,KR
AU  - Fung,YL
AU  - Spanevello,MM
AU  - Fauzi,MH
AU  - Pedersen,SE
AU  - Simonovah,G
AU  - Anstey,CM
AU  - Shekar,K
AU  - Tung,J-P
AU  - Maitland,K
AU  - Fraser,JF
DO  - 10.1016/j.thromres.2019.02.015
EP  - 45
PY  - 2019///
SN  - 0049-3848
SP  - 39
TI  - Fluid resuscitation with 0.9% saline alters haemostasis in an ovine model of endotoxemic shock
T2  - Thrombosis Research: vascular obstruction, hemorrhage and hemostasis
UR  - http://dx.doi.org/10.1016/j.thromres.2019.02.015
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000462162700009&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - https://www.thrombosisresearch.com/article/S0049-3848(19)30060-X/fulltext
UR  - http://hdl.handle.net/10044/1/74221
VL  - 176
ER  -
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